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Kamolnik,Colleen_2022-2nd-qtrAmendment Disclosure Report Cover ❑ Yes * No Use this form for general report and committee information, must be signed and submitted along with other detailed forms. Do not use this Corm to UPaale tmormauoa. 1. Committee Information e. Foil Name- c. ID Number 11foA Um In DE Distil I . Maniag Address (include City, State and Zip Code) d. hate Filed '721 01IC l -✓1 /Y2 0-110-7120 e. Phone Number ID 4 29 10 4S1o+ kA04 roC MC' ZT"7- Report Year 3. Period Start Date (mm(aaryy> 4. Period End Date (nm(aa yy)LitTreasurer FullName20220510112ozz O10I$p 201 al 6. Type of Committee (Check One) 9. Type of Report (check only one type of reportfrom one category) Candidate Campaign ❑ Party Municipal Stute/Comty Referendum PAC ❑ Referendum ❑ Organizational ❑'( gaairadonal ❑ Organizational ❑ independent Expenditure ❑ Joint Fundraiser ❑ 7hinY-five day Quarterly ❑ Pre -referendum ❑ Legal Expense Fund ❑Pre-primary ❑ First ❑ Final ❑ Predation Second ❑ Supplemental Final 7. Type of Fund- applicable, check one).. ❑Pre-maoff L3 Third Annual — ❑ Special [3d Booster Fun Semi-annual ❑Fourth ❑ Building Fund L3 Mid Year Semi-annual [3Year End ❑ Mid Year 10. Special Report Name_ ❑ Other. ❑ Final ❑ Year End 8. Number of Fundraisers this Report ❑ Special ❑ Final /ems ❑ Special 11. Account Information 11. Account Information . Financial Institution Full Name a. Financial Institution Full Name AMM(AV1 Ban k- . Purpose c. Account Code b. Purpose Code JUL 0 7 2 yt (,q m 19 n f W11d1 j d. Period Begin Balanceit. Period Begin Balance pa $ 20V. q0 Union Co. Ele tlbns CERTIFICATION I certify that the Committee or Fund is in compliance with plicable rovisions of Article er Chapter 161 clos22Ad fu d . Ifurt certify is of the NC General Statutes and that no funds are commie ed �th prohibi d or other non -disclosed foods. I further certify that this report is complete, true and correct and that I have been C S to of tions. C 1UAn m &Af M81611 0�10-llzotz Printed Name of Si er Signature of Appointed Treasurer Date OR OFFICE USE ONLY Delivery Method Date Received: o"a" Employee: ❑ Normal Mail ❑ Registered Mail Date Postmarked: Employe jjB� Hand Delivered Electronically Filed Date Scanned: Employee: 1-3Signer has not received Employee: Date Data Entered:mandatory tramtn Please Note: This form cannot be used to amend committee information such as the committee address, treasurer, assistant treasurer, custodian of books information, or account information. You must amend the Statement of Organization (CRO -2100A -E) to make committee changes. August 2008 CRO -1000 Amendment Detaffed Summary ❑ Yes A N„ __ ..r..rot _n t.r infnr,nafinn Use tms tumt 1. Com_miuee Nme�(_if apP cable_ Co ken K.Am01ni k for MD6tm+1 — - 2. o Report zcaz Setond Qua _Number Start of Election Cycle: January 1, 201 q_ Total this Reporting Period Total this Election Cvcle 4) Cash on Hand at Start $ 206 AO $ RECEIPTS 5) Aggregated Contributions from Individuals (CRO -1205) 6) Contributions from Individuals (CRO -1210) 7) Contributions from Political Party Committees (CRO -1220) 8) Contributions from Other Political Committees (CRO -1230) 9) Loan Proceeds (CRO -1410) 10) Refunds/Reimbursements to the Committee (CRO -12,40) 11) Other Receipt Sources Ila) Interest on Bank Accounts (CRO -1250) llb) Contributions from Not -For -Profit Organizations (CRO-12So) Iic) Outside Sources of Income (CRO -1250) l Id) Legal Expense Fund -Other Sources (CRO -1270) Ile) Exempt Purchase Price Sales (CRO -1265) $ $ $ $ 1 q Z . 00 $ S(0 7 ..S $ $ 3 (s1 . S $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 12) TOTAL RECEIPTS (Add fines 5,6,7,8,9,10,1la,llb,l]c,lldandlle) $ 'i.rj$ $ 22chp.so, EXPENDITURES 13) Disbursements 13a) Operating Expenditures (CRO -1310) 13b) Contributions to Candidates/Political Committees (CRO -1310) 13c) Coordinated Party Expenditures (CRO.1310) 14) Aggregated Non -Media Expenditures (CRO -1315) 15) Loan Repayments (CRO -1420) 16) Refunds/Reimbursements from the Committee (CRO -1320) 17) In -Rind Contributions (CRO -1510) $ ¢ $ 4.2.1. 7 $ $ $ $ $ .3$ , 00 $ 40-3-1-9 $ $ $ $ $ $ 29.Qa 18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17) $ $ 19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18 $ 1436 • LIPS )MMONAL IIVFORMATION 0) Non -Monetary Gifts Given to Other Committees (CRO -1330) 1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430) 2) Debts and Obligations owed by the Committee (CRO-i61o) 3) Debts and Obligations owed to the Committee (CRO -1620) 24) Account Transfers Within the Committee (CRO -1720) 5) Administrative Support QIMK ) Forgiven Loans a,f(C�AR7O�1.1440) 48 -Hour Notice Reports Sum JUL_ �'A E7) Contributions to be Refunded ,,,.. $ $ $ $ $ $ $ $ $ $ Aueust 2008 CRO -1100 Amendment Contributions from Political Party Committees Pg nr ❑ Nes k,,. Use this form to report contributions from a political party 1. Committee Fall_Name (and Fund if app _ Co I I P Fn 4i ry10 /„i „t- � f BOE” P1,514;Y4 /, 2. ID Number 3. Contributor Information Add ❑ Remove . Full Name, Mailing Address & Phone (Include city, state, & zip) .ksslut Cook for LACES Boowd of GOLUC&#t.wt lobi FIvf Craf Lrl Waw h a W t WC. 2-81-13 b. Comments c. Election Sum to Date $ 36-1. s s d.AccowatCode e. Form of Payment t. In -Kind Description g. Date (mmld;-V ) b4,1231202Z h. Amount chew $3�-►.ss $ $ . Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) h. Comments c. Election Sum to Date $ . Account Code e. Form of Payment f. In -Kind Description S. Date (mmidd/yyyy) h. Amount 3. Contributor Information ❑ Add ❑ Remove . Full Name, Mailing Address & Phone (include city, state, & zip) JUL 0 7 2022 i$ b. Comments c. Election Sum to Date d. Account Code e. Form of Payment I. Iu.Ktod Description Date (mmlddlyyyy) h. Amount Union Co. Election $ $ $ 4. Total only this Page $ 3 b-7. s 8 5. Total of ALL CRO -1220 Pages (This Gse s art be online 7 oJDetailed Summary Page CR0.1100) $ CRO -1220 NC State Board of Elections April 2W7 Amendment Aggregated Non -Media Expenditures Page or I ❑ Yes Cq No Optional form used to report NC Non -Media Expenditures of $50 or less. 1. Conunittee Full Name an app aNumber CojWkj aMOWL iD( B06 D1 I Informationd b. Account Code c. Form or Payment d. Purpose Code e. Date (rnnJddlyyyy) f. Amountove draft o 1ove I ove Ve CQcvzd $ 29-oo websovedp Z05101.)ZoL-L o6�oZj2oz.Z $2ove � { idmoved $ ❑ Remove Add $ ❑ Remove odd $ ❑ Remove Add $ ❑ Remove Add $ ❑ Remove Add $ ❑ Remove Add $ ❑ Remove Add $ ❑ Remove Add $ ❑ Remove Add ❑ Remove Add JUL $ ❑ Remove Add ❑ Remove on co. Election $ Add $ ❑ Remove 4. Total only this Page $ - CY0 5. Total of ALL CRO -1315 Pages $ 3% , 00 (This hne must be on fine 14 of Detailed SwnmmIy Pare CRO -1100) V B* - Printing C* - Fundraising D - To Another Candidate E - Salaries F* - Equipment G - Political Party H* - Holding Public OfficeExpenses I - Postage J - Penalties K* - Office Expenses Q* - Donations to Legal Expense Fund O* - Other * O -A ­.e ,,:. o dwta:lpet nxn{anation in required remarks field (2) R -131 S NC State Board of Elections f° 21109